‘Ethically speaking, mental health experts are supposed to refrain from publicly offering diagnoses for politicians. And so, for the most part, doctors and psychiatrists have refrained from joining in on the internet speculation that President Donald Trump has narcissistic personality disorder, dementia, or another condition.
But that changed in Tuesday’s New York Times, in a very public way. A pair of letters — written originally in response to Charles Blow’s scathing op-ed about the president — authored by prominent psychiatric experts faced off on the question of Trump’s mental health.
The first, written by Dr. Lance Dodes and Dr. Joseph Schachter and signed by 33 other experts, asserts that Trump is unfit to lead the country given his mental state. The latter, which was penned by Dr. Allen Frances (who literally wrote the criteria that define narcissistic personality disorder in the Diagnostic and Statistical Manual of Mental Disorders IV), sharply rebukes Dodes and Schacter’s letter…’
Dr. Frances makes several arguments. The first is that although Trump has impressive narcissism, he should not be considered to have narcissistic personality disorder because the disorder requires that his personality attributes cause him distress or dysfunction. His second objection to the letter is to reiterate the ethical standards against a clinician making a diagnosis of someone she is not engaged in treating face-to-face.
Here is my response, as a psychiatrist myself. First, the requirement that the patient be distressed is only partly true in modern practice, particularly for the subset of mental conditions known as personality disorders. Rigid personality styles often act to defend the patient against insight into their disorder and any distress caused by their way of doing business in the world. Instead, they cause distress among those around him or her. They cause dysfunction for the afflicted person without distressing her or him.
Secondly, for an ethical relativist, a sufficient emergency such as that we face now allows suspension of some ethical guidelines for the greater good.
Of course, I am far from confident that the opinion of any number of experts that this man is unfit to serve as President will actually influence anything. Frances’ coda that “the antidote to a dystopic Trumpean dark age is political, not psychological” may well be true, but we should all continue to speak our version of truth to power. I am firmly with Dodes and Schachter.